240230 Physician specialty and patient's satisfaction with communication as determinants of trust

Monday, October 31, 2011

Mihaela Moldovan-Johnson, PhD , Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
Katrina Armstrong, MD, MSCE , Director, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
Robert C. Hornik, PhD , Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA
Background: Research has consistently portrayed patient centered communication as a main determinant of patient trust in physicians, including among cancer patients. However, little is known about the relationship between physician specialty and trust, given expected differences in patient-provider communication between physician specialties. Understanding the determinants of physician trust among cancer patients provides a novel approach to improving their health outcomes. Objective: To examine whether engagement with surgeons (vs. general practitioners and oncologists) affects cancer patient's level of trust. And to further explores the role of satisfaction with patient centered communication behaviors by proposing a mediation mechanism: engagement with surgeon a satisfaction a trust. Methods: Participants: 692 randomly sampled Pennsylvania breast, prostate and colorectal cancer patients diagnosed in 2005 who completed a mail survey three years after diagnosis. Analyses: OLS regression and Sobel's mediation test. Measures: communication satisfaction and trust scales were taken from the Primary Care Assessment Survey, engagement referred to seeing/taking to a surgeon (vs. general practitioner or oncologist) most in the past year (dichotomous-yes/no). Results: Engaging with surgeons was associated with higher satisfaction with communication (B=0.192,p<0.01) and trust (B=0.367,p<0.001). Furthermore, the proposed mediation mechanism was confirmed (Coefficient=0.08,p< 0.05). Conclusions: Contrary to popular perceptions, cancer patients report higher trust in their provider if they are cared for by a surgeon than a primary care provider or oncologist, at least in part because they are more satisfied with their communication with surgeons. More research is needed to understand the reasons for these differences and their downstream impact on health outcomes.

Learning Areas:
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Identify factors that contribute to higher patient trust in physicians. 2. Describe the mechanism through which cancer patients attribute higher trust to surgeons.

Keywords: Patient Satisfaction, Health Communications

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a post-doctoral research fellow at the Annenberg School for Communication for two years studying the patient-physician relationship in the cancer context. This paper is based on data collected through the Center for Excellence in Cancer Communication Research grant, under the supervision of Dr. R. Hornik.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.